The Lowdown on Florida PPO’s
I must have this conversation everyday with people, but I am now going to put into print where I am sure no one else is ever going to read it. Should you perhaps be one of my faithful readers, then no doubt you will get a hearty education, East Coast Health Insurance-style, on the subtleties of Florida Individual and Family PPO’s.
Firstly, if you are a family then this plan will most likely be the one for you. But which one? Actually that is pretty easy as not all PPO’s are created equal which is certainly not fair. I will give you a hint though, whoever pays the highest commissions to their agents is probably gypping their customers. Let me give you a little insight from the most honest, liberal health insurance broker you will ever read.
Florida Health Insurance Commissions
The most commissions in the world are paid when I sell United Healthcare, Avalon, or Assurant, who average around 30% of your health insurance dollars to the agent. The average is probably 23% and that 23% is for the top agencies like ours. But this is no secret I am not breaking any news flashes here. The lowest commissions are paid by Cigna, and Avmed.
So, if you ever meet anyone who is selling those latter two companies then you can invite them, as they are mostly not vampires. Just for your information though, there are four PPO’s: Cigna, Humana, United, and now Coventry. Coventry has many benefits in common with other competitors.
Why? Because they have co-pays for the Emergency Room, Advanced Testing, and Routine procedures. Thus, not only are your premiums lower but your health expenses are as well as you are less likely to have to meet a large deductible. That is the end of the story as far as most people are concerned. Buy coverage from East Coast Health Insurance. Why us over other brokers?
Florida’s PPO Health Insurance Companies
And, guess what else! If a carrier decided to jack your rates up one year, we can take you right out of it and put you another carrier! (Okay, this is also good for us, as the second year health insurance commissions are a joke.)
So, what do you do if you don’t qualify for a certain plan? Then the answer is more complex, as I like to say the answer is, pick the company that gives you the most health insurance for the least money. This could be Cigna, Humana, Aetna, Avmed, Vista, Coventry, or even United Healthcare.
Let us take a look at your current health insurance and shop it for you as there is at least a 90% chance that we can get you a better plan for less money because every year new products come out. Or maybe now, because the world is coming to an end (this was a real bad recession!) you can finally qualify for a free plan from Florida or your county. We can help you! and it is free to call.
Now the boring definitions:
Overview and Definition of PPO’s
A preferred provider organization is a subscription based medical care arrangement. A membership allows a substantial discount below their regularly-charged rates from the designated professionals partnered with the organization. Preferred provider organizations themselves earn money by charging an access fee to the insurance company for the use of their network (unlike the usual insurance with premiums and corresponding payments paid either in full or partially by the insurance provider to the medical doctor). They negotiate with providers to set fee schedules, and handle disputes between insurers and providers. PPOs can also contract with one another to strengthen their position in certain geographic areas without forming new relationships directly with providers. This will be mutually beneficial in theory, as the insurer will be billed at a reduced rate when its insured utilize the services of the “preferred” provider and the provider will see an increase in its business as almost all insured’s in the organization will use only providers who are members.
Other features of a preferred provider organization generally include utilization review, where representatives of the insurer or administrator review the records of treatments provided to verify that they are appropriate for the condition being treated rather than largely or solely being performed to increase the amount of reimbursement due. Another near-universal feature is a pre-certification requirement, in which scheduled (non-emergency) hospital admissions and, in some instances outpatient surgery as well, must have prior approval of the insurer and often undergo “utilization review” in advance.
Florida PPO basics
In a PPO you get most of your health care from a network of providers, just as you do in an HMO. But you can choose to go outside of the network and pay more. Some Medicare Advantage plans are PPOs, for people with Medicare. There are also Medicare Advantage HMOs.
Primary care doctor: You can have a primary care doctor in a PPO, and it is often advisable to have one, but you do not have to. You can go to a specialist and get other services without seeing a primary care doctor first.
Networks and medical groups: Like HMOs, PPOs have a network of doctors and other providers. However, you can choose to see providers who are not in the network. You usually pay a higher PPO Cost to see these providers.
An exclusive provider organization (EPO) is a type of managed care plan that combines features of HMOs and PPOs. It is referred to as exclusive because the employers agree not to contract with any other plan.
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